Tag: Healthcare Fraud Attorney

A qui tam case in healthcare is one of the fastest growing claims in the last few decades, even surpassing military claims. Healthcare qui tam claims generally stem from improper or false billing for services or procedures, ‘off-label’ usage of FDA approved medications, or use of someone else’s health information to claim benefits.

Qui Tam Healthcare Cases and Whistleblower Laws?

Like any other qui tam cases, healthcare claims are covered by whistleblower laws. In a qui tam case, a person can raise a complaint on behalf of the government against individuals or companies that are behaving fraudulently. Once a suit is raised, the government can investigate the whistleblower’s claims and choose to join the suit; if the suit is successful, the whistleblower (or relator) may receive a reward of up to 25 percent of the funds recovered by the government in the suit.

To protect a whistleblower from retaliation by an employer or others named in the suit, qui tam laws provide up to double the damages, plus attorney fees, for any retaliatory actions taken against a whistleblower.

How Are Qui Tam Cases Verified?

A qui tam case is not as simple as seeing an attorney and signing an affidavit. There are a number of steps you need to fulfill in order to file a valid qui tam suit:

You need to have credible evidence of wrongdoing committed by an individual or a company. The evidence needs to show either harm to the government, violation of the securities and commodities laws, or harm to employees or the general public.

You need concrete evidence of wrongdoing. Documentary evidence, while not required, will vastly increase the chance of government interest.

You need original evidence that cannot be gleaned from other sources. Evidence taken from public sources like the internet, TV news, or pubic government records cannot be used in a whistleblower claim.

You need to file right away. Under the ‘first to file’ rule, a whistleblower cannot file a claim if another whistleblower has filed one using the same evidence.

You need to remember the statute of limitations. It varies depending on the industry, but can range from 30 days to 6 years after the violations.

Can you Fake a Qui Tam Claim?

As with any suit, there may be unscrupulous folks who try to bring false claims under the False Claims Act. This usually happens in order to collect rewards under the qui tam provision. These false claims will not hold up under scrutiny, nor will the evidence bear them out. Be aware that you may also be liable for perjury should you lie under oath.

Have questions about a qui tam case in healthcare? Call the Bothwell Law Group at (770) 643-1606.

When to report fraud is a question you may be facing if you are aware of it happening but aren’t directly involved. If you don’t report it, will you be in trouble? There are a lot of unknowns in the world of whistleblowing and fraud. It’s time to dig into it for some insight and to give you direction and peace of mind.

What Do You Mean Report Fraud?

Fraud in this context refers to businesses that fraudulently take money from the US government in a variety of different ways, including Medicare fraud, criminal defense contract fraud, and nursing home fraud, to name just a few of the most common scenarios. There are many different ways people charge government programs for goods and services that are either not delivered or not justified.

Because fraud exists on such a broad level, laws have been created to encourage private citizens to report fraud when they witness it. These rules are known as False Claim Act laws, and they date back to the days of Abe Lincoln and the Civil War. Because people aren’t prone to report things that could cause them a backlash, the False Claims Act includes provisions for the whistleblower to receive a portion of any money recovered in a lawsuit. There are also laws to protect the whistleblower from losing their job.

Some of these laws and protections directly address just when and how we need to report fraud once we know about it. Surprisingly, there is not one simple, easy to understand rule. The law varies according to different industries, and it even changes from state to state.

The important thing to remember is if you are aware of fraud, you are likely obligated to report it, or else you may be found guilty of defrauding the government as well.

When Do I Need to Step Forward and Report Fraud?

Most people who report fraud are employees of the company committing the fraud. For example, one of the most common areas of fraud is within the program of Medicare. If you work in a doctor’s office as a nurse and never touch the bookwork, you probably have no idea the fraud is taking place. If you transfer to the accounting department, however, you may begin to see a problem.

Even if a person is involved in the actual fraudulent activities, they can still be the reporting whistleblower. The law does stipulate that fraudulent charges in Medicare cases need to be brought within 30 days of discovery of the practice. If a person is aware of the fraud and fails to report, they are in danger of prosecution under the law. However, even though the law allows for the prosecution, it rarely actually happens.

Even if a business or individual self-reports their participation in the fraud, they are not exempt from possible prosecution. Often, however, a judge will levy a lower penalty upon a voluntary disclosure of the activity.

How Do Your Report Fraud to the Government?

Fraud is reported with a complaint made in District Court. The best practice for any whistleblower is to hire an attorney familiar with the False Claims Act. Choosing an attorney who works exclusively in this type of law is always the wisest decision.

Because there are so many ins and outs regarding the statutes of limitations, as well as different kinds of both penalties and protections for whistleblowers, it is critical to hire an attorney who understands all of the particulars of this area of law. The attorney will verify the facts in the case and prepare the complaint on behalf of the whistleblower.

Once the paperwork is brought to a district court, it is put under seal, prohibiting anyone, including the whistleblower, from breaking that seal by disclosing anything. The seal protects the identity of the whistleblower at this stage of the process. In fact, the defendant doesn’t even know an investigation exists. The original seal on the case is for six months. This timeframe is almost always extended, giving the government many months or even years to perform their investigations.

Once the inquiry is complete, the government makes a decision whether or not they will intervene, or take over, in the case. If the federal government does decide to step in, they take over the prosecution of the case. The court serves the defendant notice, and quite often a settlement is reached without actually going to court

If You Are Aware of Fraud, Report It to a Whistleblower Attorney

If you are aware of fraudulent billing practices taking place at your place of work, or any organization for that matter, contact an attorney who works in False Claims Act law right away. Even if you are knowingly participating in the illegal activity, you should retain an attorney and file the complaint.

If you are not actively involved and the court determines proof of fraud, you are entitled to between 15% and 25% of the monies recovered. The amount of that reward can reach millions of dollars in some cases. Have questions about when to report fraud? Contact the Bothwell Law Group online now.

If you’re wondering how to report healthcare fraud, you’re probably already in an uncomfortable position. Someone you work for (or with) is doing something illegal to defraud the government and the healthcare system it supports. You’ve found out, and now you think you need to do something about it.

Here are the steps you should follow if you ever think you need to file a report:

How to Report Healthcare Fraud: Gather Evidence

When reporting any fraud or misconduct, you need more than just hearsay. Ideally, you’ll have a paper trail consisting of invoices, vouchers, emails, database records, and any other physical items that paint the picture about what exactly is going on.

Once you have everything in order, do not talk to anyone about it yet. Not a friend, not your company, and not the press. This is important because the instant you disclose certain information, you lose options. You also potentially implicate yourself in contractual and non-disclosure violations.

Simply gather the information for now, and keep it in a safe place.

How to Report Fraud: Understand Your Options

You have three main options when it comes to reporting suspected fraud:

Notify the agency being harmed. Each agency has its own Inspector General, responsible for investigating any fraud relating to their department.

Notify the FBI. You can always report fraud anonymously through the FBI tip hotline, or by contacting your local FBI office.

File a qui tam lawsuit under the federal False Claims Act. Under the FCA, individuals can file a civil lawsuit on behalf of the U.S. government.

The first two options above are fairly straightforward, and are certainly good choices in specific and simple scenarios. However, the third option is potentially the most lucrative of the three.

How to Report Fraud: Consult a Qui Tam Lawyer

In the event you need help making the best choice, or you’ve already decided to file a qui tam lawsuit, it’s time to consult a lawyer. Your lawyer can review the evidence you’ve provided, and help you determine if it’s enough to bring a lawsuit. What your lawyer is looking for is the strength of the evidence, and the size of the fraud in question; both factors will determine your likelihood of success

After reviewing the evidence, your attorney will likely advise on which of the three options is in your best interest given the facts of the case. In the event you decide to proceed with a lawsuit, you can expect them to do the following:

File a complaint with the U.S. District court under seal. The term “under seal” means only the government and you are aware a suit has been filed. It gives them time to conduct their own investigation

Work with the government to help determine if they want to join your case

Carry your case, working with the government (in cases where they intervene), on your behalf

Anything Else You Need to Know about Healthcare Fraud Reporting?

Still have questions about how to report healthcare fraud? Click here to contact the Bothwell Law Group online.

The False Claim Act for healthcare is essentially a small component of a much larger set of regulations making it a crime to knowingly record or file a false claim, regarding any federal healthcare program. While Medicare and Medicaid are both considered federally funded programs, it also extends coverage to any plan or program providing health benefits (including through insurance) which receives any funding from the federal government or state-sponsored healthcare system.

Examples of fraud covered under the FCA include billing for services never received, double billing (billing for the same service more than once), or making any sort of false statement in an effort to obtain payment for services.

Penalties Associated with Falsifying Claims

Any violation discovered and prosecuted under the FCA carries stiff penalties. From a financial perspective, an individual or organization is on the hook for three times the amount of the falsified claim, plus an additional penalty of up to $11,000. These penalties are on a per claim basis, so in cases of systematic fraud, the dollars begin to add up quickly.

Violations can also be counted as a felony charge, and result in jail time, additional fines, or both. Anyone found to have received a benefit by way of fraud, made a fraudulent statement, or worked to conceal material facts can be held liable.

Protection for Individuals Reporting Fraud – aka – Whistleblowers

Any employee who reports a violation under the False Claims Act is legally protected from harassment, suspension, or being fired as a result of their reporting. If the court finds the employee did suffer discrimination, they may be awarded two times their back pay (with interest), immediate reinstatement of their original job, and additional compensation for costs incurred and any damages suffered as a result.

When the Qui Tam Provision May Apply

Qui tam is an abbreviation for a Latin phrase that very loosely translates to someone who brings a case on behalf of themselves and their “king”. Basically, it means you can sue someone on behalf of the government, and be paid a percentage of any of the funds recovered as a result of the lawsuit, even if you were engaged in, or a part of, any illegal activities covered by the FCA.

It is worth noting here that any awards received as qui tam payments are considered ordinary income, and taxed as such by IRS. While previous qui tam relators have attempted to have these payments classified as capital gains, the Ninth Circuit Court of Appeals upheld the IRS’ position on income classification.

Think You Have a False Claim Act for Healthcare Case?

Contact the experienced attorneys at Bothwell Law Group by calling 770.643.1606, and find out if the False Claim Act for healthcare applies to your situation.